AccountId: 011433970860
ContactId: aefe0304-12ac-4240-8fcb-03f112b75082
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430000 ms
Total Talk Time (AGENT): 154352 ms
Total Talk Time (CUSTOMER): 149100 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/aefe0304-12ac-4240-8fcb-03f112b75082_20250106T13:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] and I'm calling from provider's office to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes and we have this day is going.
[AGENT][POSITIVE] OK, well, my day is going well. um um I can definitely help you with the claim denial, um, clarity. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the name is going to be
[CUSTOMER][NEUTRAL] [PII], and my callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] And may I have um the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is going to be.
[CUSTOMER][NEUTRAL] D. Delta 43731921.
[AGENT][NEUTRAL] And do you have the member's ID card available?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Uh, no, it's going to.
[AGENT][NEUTRAL] OK, do you have the member's social or, or I can take the member's first. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, I have it.
[CUSTOMER][NEUTRAL] I have a number social number, social security number.
[AGENT][POSITIVE] OK, I can have that when you're ready.
[CUSTOMER][NEUTRAL] Yeah, the SSN number is going to be.
[CUSTOMER][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just give me one moment.
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] No, that's not a social. What's the member's first and last name?
[CUSTOMER][NEUTRAL] The first name of the member is going to be [PII] and the last name is going to be [PII].
[AGENT][NEUTRAL] And um does she spell the first name, [PII]?
[CUSTOMER][POSITIVE] Yeah, [PII], it's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] No, we don't have any claim number on our end.
[AGENT][NEUTRAL] You don't have a claim for the denial you received a claim number?
[CUSTOMER][NEUTRAL] Yeah, we, we don't have any claim number on your, on the.
[AGENT][NEUTRAL] OK, I can look at with the name. Hold on one second.
[AGENT][NEUTRAL] So I'm just waiting for the name to pop up hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And this is for medical, dental, what type of um claim you're looking for?
[CUSTOMER][NEUTRAL] It's for medical.
[AGENT][NEUTRAL] OK, I think I just found the the policy. Hold on one moment.
[AGENT][NEUTRAL] Can you verify her date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's date of birth is going to be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, this is the policy. So all the information provided is a verification of benefits, not a guarantee of payment. And did you need the policy number?
[CUSTOMER][NEUTRAL] Uh, yeah. Could you please provide me the policy number?
[AGENT][NEUTRAL] OK, the policy number is 255.
[AGENT][NEUTRAL] 1147.
[AGENT][NEUTRAL] And may I have the date of service for the call, um, for the call, for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yeah, the date of service of this claim is going to be [PII] with the total charge of $452 even.
[AGENT][NEUTRAL] Thank you. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Um, we actually don't have a claim on file for [PII]. We've only processed one claim for her, but it's a different data service.
[CUSTOMER][NEUTRAL] So you don't have any claim on file for this one. We, uh, just give me one moment, uh because on our end, the claim has been
[CUSTOMER][NEUTRAL] Submitted on [PII]. Could you please check the mailing address is correct, which we have submitted the claim as and paper form which. Can I provide you the mailing address?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's going to be [PII]. It's the correct mailing address.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Uh, so we can resubmit the claim once again for you.
[AGENT][NEUTRAL] Yes, you can resubmit the claim, um, there's no timely filing limit, but
[AGENT][NEUTRAL] This policy wasn't active on your data service. Um, this policy became effective on, oh, I'm sorry, it was, it was [PII], my apologies. Yes, you can, you can file it anytime it was active on your data service.
[CUSTOMER][NEUTRAL] So the member is active on our data service. Could you please provide me the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and still active on the plan?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Still active on the plan with no time and do you have the payer ID?
[AGENT][NEUTRAL] The payer ID is 64.
[AGENT][NEUTRAL] 556.
[CUSTOMER][NEUTRAL] 645-556
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And there is no time limit for the claim submission.
[AGENT][NEUTRAL] Correct. As long as the policy was active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please provide me the call reference number for this claim?
[AGENT][NEUTRAL] Sure, um, the call reference number would be, well, there's no call reference number, it would be my name and today's date. So that's [PII], and then today's date.
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] Yes, today's uh.
[CUSTOMER][POSITIVE] Uh thank you for the information and uh thank you for your assistance.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Nothing else apart from that.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.